What Is Renal Arteriovenous Fistula?
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Renal Arteriovenous Fistula - Causes, Symptoms, Diagnosis, and Treatment

Published on Mar 01, 2023 and last reviewed on Jun 08, 2023   -  4 min read


Renal arteriovenous fistulas are connections between a renal artery and vein due to various causes. The article explains the topic in detail.


The arteries are blood vessels that take blood from the heart to different body organs. Veins are the blood vessels that carry deoxygenated blood from the other organs back to the heart. A fistula is a link that joins a vein with an artery. This connection causes large blood vessels.A renal arteriovenous fistula is a rare, abnormal connection between the arteries and veins of the kidney.

What Are the Types of Arteriovenous Fistulas?

Arteriovenous fistulas are classified into two types based on their cause of formation:

  • Traumatic Arteriovenous Fistulas- These fistulas are caused by penetrating injuries, biopsies, or surgeries. A common cause of traumatic arteriovenous fistula is a percutaneous renal biopsy (a kidney biopsy done by inserting a fine needle through the skin tissue), which accounts for about seven percent to eleven percent after renal biopsy. Most fistulas due to renal biopsy remain asymptomatic and resolve within two years, while a few can be symptomatic and require treatment.

  • Non-traumatic Arteriovenous Fistulas- These fistulas are present since birth and are not a result of any traumatic injury.

What Are the Causes of Arteriovenous Fistula?

A renal arteriovenous fistula is a rare condition present at birth (congenital) or is formed late in life (acquired).

  • An Injury to the Skin- An arteriovenous fistula may be formed due to a gunshot, stab injury, or a surgical wound that occurs when an artery and a vein are near each other.

  • Congenital Arteriovenous Fistulas- During pregnancy, the arteries and veins in some kids do not develop as they should, giving rise to congenital arteriovenous fistulas.

  • Genetic Conditions- Sometimes, genetic predisposition is associated with the development of arteriovenous fistula.

  • Dialysis-Related Surgery- Individuals having end-stage kidney failure might undergo surgery to create an arteriovenous fistula in the arm to carry out dialysis easily.

  • Renal Biopsy- Renal biopsy is an invasive diagnostic procedure in which a small amount of diseased tissue is removed from the organ and evaluated under a microscope.

  • Nephrostomy- A nephrostomy is an opening prepared between the kidney and the skin at the back of the body. It helps in the removal of urine from the kidney. A catheter is inserted through the opening into the kidneys. The urine drains out via the tube and collects in a bag outside the body.

  • Kidney cancer.

What Are the Signs and Symptoms of Renal Arteriovenous Fistula?

Most cases of renal arteriovenous fistula are asymptomatic.

  • Hypertension.

  • Pain in the lower abdomen.

  • Pain in the flanks.

  • Acute urinary retention- Acute urinary retention (AUR) is the inability of an individual to pass urine. It is one of the common urologic problems.

  • High-output cardiac failure- In this condition, the heart cannot supply sufficient blood required by the body. It is a less common type of heart failure.

  • Renal insufficiency- in this condition, there is poor blood flow to the kidneys due to reduced blood flow caused by kidney artery disease.

  • Hemorrhage or thromboembolic phenomenon.

  • Hematuria- This is a condition where there is a presence of blood in the urine.

  • Dyspnoea- This is a condition where breathing is difficult.

  • Tiredness.

How Are Renal Arteriovenous Fistulas Diagnosed?

The various diagnostic procedures for detecting renal arteriovenous fistula are:

  • Ultrasound- Ultrasound uses sound waves to record images of the organs. For example, renal arteriovenous fistulas are usually visible in B-mode ultrasound. B-Mode is a two-dimensional image comprising bright spots representing ultrasound echoes.

  • Doppler Ultrasound- A doppler ultrasound is a noninvasive diagnostic test used to evaluate the blood flow through the blood vessels by bouncing the high-frequency sound waves off the red blood cells. Two types of doppler ultrasound techniques are used:

  • Color Doppler- In this technique, a computer changes sound waves into various colors. These colors suggest the speed and direction of blood flow. Power doppler is a new form of color doppler. It can show a more detailed blood flow than the standard color doppler. Color doppler image shows a flash of color resulting from the vibration of the soft tissue surrounding the renal arteriovenous fistula, leading to a mosaic of colors over the adjacent soft tissue. The artery and vein can be seen when adjusting the color doppler to a higher frequency.

  • Spectral Doppler- This technique displays the velocity over time. The velocity curves show the direction of blood flow and the change in speed. It shows the rate at which the blood flows within the artery and the vein. The artery shows a high-velocity and low resistance flow, whereas turbulent, pulsatile flow in the vein.

  • CT Angiogram- Computed tomography (CT) is the imaging technique that combines X-rays taken from various organs and computer technology to get images of internal organs in detail. CT angiogram is an imaging technique that shows whether the blood flow bypasses the capillaries or not. A contrast media or dye is injected intravenously for this test. The contrast media makes the blood vessels visible in the images. In addition, it may detect abnormal renal arteriovenous communication with other aneurysms.

How Are Renal Arteriovenous Fistulas Treated?

Renal arteriovenous fistulas may resolve on their own. It is usually treated when symptomatic, significant, extra-renal, or outside the kidneys.

  • Catheter Embolization: Transcatheter embolization is the first line of treatment for fistulas. In this procedure, the blood supply to a tumor or an abnormal tissue region is blocked. During the process, a cut is made in the inner thigh, and a thin, flexible tube called a catheter is inserted within an artery adjacent to the arteriovenous fistula. A small coil or stent is placed at the fistula to reroute the blood flow. The hospital stay is around a day. Daily activities can be started after a week.

  • Surgery: Large renal arteriovenous fistulas that cannot be treated with catheter embolization might need surgery. The surgical treatment is either partial or total nephrectomy. Nephrectomy is the surgical removal of a part of or the whole kidney.


Renal arteriovenous fistulas are rare abnormalities directly linked to the renal artery and vein. It is primarily a result of trauma, while a few cases are present since birth. Many of these lesions are small and clinically irrelevant since they are asymptomatic. These small fistulas do not need any treatment. Larger symptomatic lesions are treated with catheter embolization. Surgery is the best option for lesions that cannot be treated with any other modality. The prognosis and recovery after the procedures are reasonable.

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Last reviewed at:
08 Jun 2023  -  4 min read




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